ERDoc

No, she deserves the compassion. I'm not a big fan of people who smoke crack, but damn. This woman is near the end, let her have whatever fun she wants. You also can't force her to go against her will.

Did they send this woman to the ER for her drug test? If so, I agree with OP. This is a colossal waste of time and resources. This is nothing more than a dump from the sending facility. We have a facility that does similar stupid shit. If this pt showed up in the ER, I wouldn't even unload her. Quick exam and ask if she has any complaints or wants to be seen? No? OK, back you go. The facilities desire to screw over the pt is not an indication for unnecessary testing in the ER nor is it medically indicated.

Holy chemistry set Batman! First, let's cut back on a bunch of these meds. There is no need for so many and they are just working against each other. I would get rid of the Fentanyl and Versed drips. That alone may or may not help the pressure. Try to titrate down the propofol. Can you confirm some labs? I question the hgb, Cr, BUN (maybe you are using different units than I am used to). Are we able to get a CT angio of her chest? Any concerns for pathology elsewhere (ie abd and pelvis)? The ABG is concerning but I will let someone else interpret it.

I don't think you will find any precedence for this but you will find lots of opinions. As stupid as it is, it seems like a HIPAA violation on both parts. As you mentioned, crew A gets a violation for leaving protected pt information where it can be accessed by unauthorized individuals. Lt B also could get a violation for having the protected information in a place where it can be accessed by unauthorized individuals. Look at the many cases where a computer or hard drive get stolen from a car. Lt B should have secured the paper to the best of his ability.

Immobilize and get the pt into the ambulance and out of public view as soon as possible. Strip him and put on the monitor. Have your (hopefully) competent partner get a real set of vitals.

Since no one else has participated, I guess I will start off. What is the pt's history? What antibiotics is she on and why is she on them if she has influenza? How long has the vigorous bubbling gone on and what happens if we clamp the chest tubes at the skin? Bad things are going on so let's get a chest xray if there isn't a current one.

No, I was trying to remember where that pic came from but couldn't find it with a very brief google search. It's a similar pic.

Wait, you mean this map isn't right?

Yeah, I went in to medicine for the money, fancy cars, yachts and supermodels. Surprise! I have student loans equal to a second mortgage, drive a GMC, no boat, a wife and 4 kids and a government telling me how to do my job and reminding me how bad I am at doing it. Those TV shows lied to me!

Well, those of us from the island like to pretend we are from the city.

Probably because most of FDNY and NYPD lives in Nassau or Suffolk, or because they didn't want friends arresting friends when the inevitable fight broke out.

And they call going from medic to FF a promotion?

Lawyers call their customers 'clients.' If the lawyers do it, it can't be good, especially for medicine.

Of course you do, becaue the govt says that your ER doc can't fire you.

I think med school and residency was less hours than that! Finney, this is from the NYS DOH website: http://www.health.ny.gov/professionals/ems/policy/08-05.htm

I wish I knew: 1. How badly the govt was going to destroy the practice of medicine 2. How much I would rather work 12hr shifts instead of 8hr 3. How much someone could miss being out on the road, knowing whether it is day or night, sunny or raining 4. How important nights, weekends and holidays become when you have a family 5. How much you can miss 'home' 6. Student loans really do need to be paid back eventually

Fixed it for you. Sorry, this is just a huge pet peeve of mine. IMO, calling our patients 'customers' insults the provider-patient relationship. That relationship implies a certain level of trust and care that is above and beyond 'customers'. McDonalds and Macy's have customers, we have patients. It is a much more personal relationship. RseCty, congrats on the job and good luck.

EKGs only tell you about the electrical state of the heart, so it would not tell you anything about contraction or relaxation of the myocardium. Are you sure about that polarization thing?

I can't help you with the online stuff, but if you want an idea of what works to fix the issue of retention, look to Long Island, especially Suffolk County. I think you will be hard pressed to find any place that allows an original certification to be done online. It is one of those things that is best taught hands-on, even in the classroom.

We recently replaced the internal pacer at one of our hospitals. I looked at the manual and it was manufactured in 1974.

Island wouldn't be a whacker because by 'barn' I assume he means the garage/quarters for his ambulance. It's a northeast term, much like bus.

It's not just the laypeople. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3421978/ http://pediatrics.aappublications.org/content/124/4/e729.full.pdf http://www.ncbi.nlm.nih.gov/pubmed/10424862

Haha! I didn't even think about it that way but I will say that the foot pump can be modified. Perhaps I have said too much.

Well, I do wear the MAST when I sleep so I guess I am a whacker.

We grossly overestimate blood loss. Putting a few drops of blood in some water will make the water look like blood. There have been studies (I don't have the time to search for them) that has shown we are horrible at estimating blood loss. This could have been some pulmonary edema with more than average blood, a punctured blood vessel, an aortotracheal fistula, etc.